![]() ![]() The introduction of DSM classification in the 1950s and 1960s was an attempt to improve communication between mental health professionals and achieve reliability among clinicians and researchers 7. Although conceptualizations of negative symptoms have been refined over the years 4, reduced motivation and diminished emotional expression are still considered core facets of the illness 5, 6. Similarly, Bleuler pointed out that “indifference seems to be the external sign of their state…The will…disturbed in a number of ways, but above all by the breakdown of the emotions…The patients appear lazy and negligent because they no longer have the urge to do anything either of their own initiative or at the bidding of another. Less known, but equally central, is the role Kraepelin attributed to avolition in its vital impact on the manifestation of schizophrenia, “a weakening of those emotional activities which permanently form the mainsprings of volition…“ 2, 3. Kraepelin defined schizophrenia or “dementia praecox” as an illness with a progressively deteriorating course across multiple features starting in the late teens or early adulthood. Negative symptoms were initially described by Kraepelin and Bleuler, the founders of the modern schizophrenia construct 1– 3. Implications for targeted treatment development and clinical trial design are discussed. Avolition may therefore reflect the most critical treatment target within the negative symptom construct. Network analytic findings also indicate that avolition is highly central and interconnected with the other negative symptom domains in schizophrenia, and successfully remediating avolition results in global improvement in the entire constellation of negative symptoms. The current review synthesizes a body of emerging research indicating that avolition may have a special place among these dimensions, as it is generally associated with poorer outcomes and may have distinct neurobiological mechanisms. Modern conceptualizations of the structure of negative symptoms posit that there are at least two broad dimensions (motivation and pleasure and diminished expression) or perhaps five separable domains (avolition, anhedonia, asociality, blunted affect, alogia). Negative symptoms have long been considered a core component of schizophrenia. ![]()
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